Individual
KELLERYN V WOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
F.N.P.
Contact information
Practice address
800 MAIN ST, SOUTH PORTLAND, ME 04106-6049
(207) 828-1133
(207) 828-8077
Mailing address
800 MAIN ST, SOUTH PORTLAND, ME 04106-6049
(207) 828-1133
(207) 828-8077
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
363L00000X
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
248410099
—
ME
Enumeration date
12/06/2006
Last updated
02/04/2009
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